a physician a building location a clinical trial a department
BCM - Baylor College of Medicine

Giving life to possible

Baylor Facial Plastic Surgery Center

Hair Restoration

Medical treatments, including Finasteride (Propecia) and topical minoxidil (Rogaine), and Low Level Laser Therapy (LLLT) are available for the treatment of hair loss. Finasteride, which is only approved for use in males, works best for early or moderate hair loss, but aids those with more advanced loss in preserving their remaining hair. Minoxidil, which can be used by both men and women, slows hair loss but is less effective in helping new hair to grow. Low Level Laser Therapy can be used in both men and women, and both slows down hair loss and helps to regrow hair in some patients. All of these medical treatments need to be used on a continual basis in order to sustain results.

Hair loss can affect both men and women: those experiencing noticeable hair loss is 50 percent in males by age 35, and 25 percent of women by age 55. For men, heredity is the main factor, while in women, only 50 percent experience a hereditary hair loss. The rest have hair loss as a result of hormonal changes, dermatological or systemic conditions.

Surgical advances in hair transplantation, with improved results, have stimulated interest in hair replacement surgery.

What can hair replacement surgery do for me?

The goal is to improve appearance as much as possible, while understanding the different options available for your particular type of hair loss.

Male pattern baldness, with a receding hairline or thinning at the crown, is the easiest condition to correct. Women with female pattern hair loss can also benefit. All hair replacement techniques use your existing hair.

Transplant techniques such as mini- and micro-grafts have given way to follicular unit transplantation (FUT), which relocates the hair in the smallest anatomical unit and leads to a change in the fullness of the hair and a natural appearance. Texture and color of hair and skin affects outcomes: coarse-textured, light-colored hair tends to produce a look of greater density than fine, darker hair. The contrast between hair color and skin color is also considered.

Sixty percent of our patients achieve satisfactory results in just one session; the other 40 percent elect to have more than one procedure to achieve increased density. It takes about 12 months to see the final results of a FUT procedure.

Hair replacement surgery may be combined with medical treatments, such as finasteride, minoxidil and LLLT, to slow down or stop future hair loss, and accelerate growth of the grafts.

Hair replacement should be individualized for each patient and your physician can provide an estimate of the improvement that may be achieved.

Am I a good candidate for hair replacement surgery?

If hair replacement surgery is done for cosmetic reasons, it is usually not covered by insurance. But, if it is necessary for hair loss from accidents, burns, disease or trauma, it may be reimbursed either in part or in whole. Patients should check with their insurance carrier for information on coverage.

During consultation, your physician will discuss whether hair replacement surgery is right for you, and, if so, which type.

The best candidates for hair replacement surgery are those who:

  • Have donor hair on the side or the back of the scalp
  • Are generally healthy
  • Do not smoke (not prohibitive)
  • Have realistic expectations about outcomes and the need for multiple procedures

How is hair replacement surgery performed?

Most hair transplant surgeries are performed under local anesthesia on an out-patient basis. Surgery can take from three to eight hours.

The most common technique for hair replacement surgery, follicular unit transplantation (FUT), involves removing a strip of hair-bearing scalp from the back of the head. Using magnification, this strip is then divided into grafts, each containing one follicular unit, that are carefully inserted into tiny slits in the scalp to avoid injury to any existing hair follicles, and ensuring that they are transplanted at the same growing angle as the other hairs that are present. Some grafts, FUTs, may contain up to five or six hairs, while some will contain only one to two hairs. The use of small follicular unit grafts creates a more natural look.

Less commonly, skin flap surgery may also be used to cover balding areas, usually as an adjunct technique in injury reconstruction or updating old hair transplant procedures. A portion of the balding scalp is removed, and a section of hair-covered scalp is moved and sutured in its place. New hair growth can generally cover the resulting scars. Scalp reduction surgery involves covering a bald spot at the crown of the head by removing the hairless area and stretching the adjacent hair-covered scalp over the opening.

What to expect after hair replacement surgery

Intermittent soaks and sprays are applied for the first four postoperative days. The donor area sutures are usually removed within 10 days. Small scabs will form on the grafts, but will usually be gone within a week. You will be allowed to wash and blow dry your hair on the day after surgery.

Localized swelling and bruising are possible, although minimized by carefully following the postoperative instructions. Your head and scalp may feel tight, and you may experience some aching, which is controlled with a mild pain medication. Any numbness that occurs at the donor or recipient site usually disappears within two to eight months after surgery.

It is crucial that all postoperative instructions given by your physician are followed. Patient are asked to use moist compresses and a therapeutic spray and to sleep in a semi-upright position for two to three days after the procedure.

About six weeks after the procedure, the newly transplanted hair often appears to fall out, but this is normal. The new hair growth actually takes about 10 to 16 weeks to develop.

Touch-up procedures, including additional surgeries, may be necessary to achieve a natural look, adjust the hairline, or remove excess skin.

What are the risks of hair replacement surgery?

As with any surgical procedure, infection may occur. Excessive bleeding and wide scars may sometimes result from scalp-reduction procedures, but most scars can be camouflaged by the surrounding hair. There is some risk in transplant procedures that a graft "will not take." Repeat surgeries may be necessary. The risk of all these complications occurring in our hands is less than 0.5 percent.

Read more about hair replacement: